Delphi panel finds distinct differences in the
way common terms are understood by health care professionals,
illustrating the complexity of concepts integral to health care
transformation
Health care professionals, policymakers, and
payers should consider differences when creating policy and
implementing payment methodologies associated with value-based care
and population health
Today’s U.S. health policy initiatives, including those from the
Centers for Medicare & Medicaid Services, are aiming to derive
more value from the health care dollar. This involves a shift from
reimbursement based on volume to reimbursement based on the value
of care delivered.
With this shift comes a new set of terms being used across the
industry, like value-based care and population health. Yet these
terms have been found to hold different meanings for different
stakeholders, and that has a variety of consequences for health
care professionals, health care policymakers, patients, and payers,
to name a few.
Humana Inc. (NYSE: HUM), one of the nation’s leading health and
well-being companies, and Penn Medicine, set out to find consensus
on three terms. Through the use of a Delphi research method that
convenes a panel of experts to arrive at a group opinion or
decision, lead researcher Marilyn Schapira, MD, MPH, led the panel
through multiple rounds of surveys to achieve broadly applicable
definitions for three terms: value-based care, value-based payment,
and population health.
After more than six months, the Delphi panel reached consensus
on the term value-based payment but, after three rounds of ratings,
was unable to arrive at a consensus definition for value-based care
and population health, though distinct areas of agreement and
disagreement were made clear. These findings were presented June 3
at the AcademyHealth Annual Research meeting. See infographic that
summarizes process and findings.
Findings illustrate complexity of concepts integral to
transformation of health care
Researchers reviewed the peer-reviewed literature to collect
current definitions in use to be evaluated by the Delphi panel.
Then the panel met in person in early 2018 to discuss goals of the
process and key components to use in the definitions. Ultimately,
after three rounds of rating definitions and potential components
for each of the terms, the Delphi panel achieved the following:
A consensus definition
of value-based payment: “Value-based payment aligns
reimbursement with achievement of value-based care (health
outcomes/cost) in a defined population with providers held
accountable for achieving financial goals and health outcomes.
Value-based payment encourages optimal care delivery, including
coordination across health care systems and community resources, to
improve health outcomes for both individuals and populations.”
No consensus definition
for value-based care or population health, but specific
areas of agreement and divergence became clear, illustrating the
complexity of the concepts.
AREAS OF AGREEMENT AREAS OF
DISAGREEMENT VALUE-BASED CARE
Value-based care applies to individuals and populations and is
determined by health outcomes and cost
- Whether to highlight the patient experience and
perspective
- Whether to include the time horizon over which value-based care
is provided and the duration over which it is measured
- The exact terms to use for the numerator and denominator of the
value equation
- Concept of societal constraints on resources
POPULATION HEALTH
- Population health refers to the distribution of health outcomes
in a defined group of individuals.
- Population can be defined by a range of factors that people
have in common
- Whether or how to include social and other determinants of
health in the definition
- Explicitly identifying different types of populations
- Specifying domains of health or global outcomes (functional
status, quality of life, wellness)
“We sponsored this research because, in talking with physicians
and health systems, we were finding that increasingly the words we
were each using to discuss value-based care and population health
were incongruent. That was becoming more and more problematic as
parties were coming together to discuss how care was being
delivered, the way that care was being compensated, and the
outcomes that care was achieving,” said William Shrank, MD, MSHS,
Chief Medical Officer for Humana. “These findings illustrate the
differences we, in the health care industry, should consider when
creating policy and implementing payment methodologies associated
with value-based care and population health.”
Delphi panel comprised esteemed leaders in health
care
The Delphi process is a systematic, structured consensus-forming
method using recognized experts who represent different
perspectives relevant to the question posed. The Delphi process has
proven useful to answer questions and address topics that cannot be
addressed though clinical, experimental, or epidemiological
methods. The Delphi process has been used in the past, for example,
to define imaging procedures1, establish clinical consensus for the
diagnosis and treatment of patients with certain pathologies2, and
define advance care planning3.
Eighteen experts from a diverse range of professional
backgrounds and geographic locations made up the Delphi panel to
develop consensus statements for the terms value-based care,
value-based payment, and population health. They included:
Alan Balch, PhD, National Patient Advocate Foundation;
Richard J. Baron, MD, MACP, American Board of Internal
Medicine; Patricia Barrett, MHSA, National Committee on
Quality Assurance; Roy Beveridge, MD, Humana; Tracie
Collins, MD, MPH, MHCDS, University of Kansas School of
Medicine; Susan C. Day, MD, Penn Medicine; Rushika
Fernandopulle, MD, MPP, Iora Health; Anders M. Gilberg,
MGA, Medical Group Management Association; Douglas E.
Henley, MD, FAAFP, American Academy of Family Physicians;
Amy Nguyen Howell, MD, MBA, FAAFP, America’s Physician
Groups; Christine Laine, MD, MPH, FACP, Annals of Internal
Medicine, American College of Physicians; Christina Miller,
MSS, Health Promotion Council of Southeastern Pennsylvania, Inc.;
Jaewon Ryu, MD, JD, Geisinger Health System; Donald F.
Schwarz, MD, MPH, MBA, Robert Wood Johnson Foundation; Mark
Schwartz, MD, FACP, New York University; Jeffrey
Stevens, MD, Summit Medical Group; Elizabeth Teisberg,
PhD, Dell Medical School, University of Texas at Austin; Ken
Yamaguchi, MD, MBA, Centene Corporation.
About Humana
Humana Inc. (NYSE: HUM) is committed to helping our millions of
medical and specialty members achieve their best health. Our
successful history in care delivery and health plan administration
is helping us create a new kind of integrated care with the power
to improve health and well-being and lower costs. Our efforts are
leading to a better quality of life for people with Medicare,
families, individuals, military service personnel, and communities
at large.
To accomplish that, we support physicians and other health care
professionals as they work to deliver the right care in the right
place for their patients, our members. Our range of clinical
capabilities, resources and tools – such as in-home care,
behavioral health, pharmacy services, data analytics and wellness
solutions – combine to produce a simplified experience that makes
health care easier to navigate and more effective.
More information regarding Humana is available to investors via
the Investor Relations page of the company’s web site at
www.humana.com, including copies of:
- Annual reports to stockholders
- Securities and Exchange Commission
filings
- Most recent investor conference
presentations
- Quarterly earnings news releases and
conference calls
- Calendar of events
- Corporate Governance information
- Boccardi M, Bocchetta M, Apostolova LG,
et al. Delphi definition of the EADC-ADNI Harmonized Protocol for
hippocampal segmentation on magnetic resonance. Alzheimers Dement.
2015;11(2):126-138.
- Bartlett SJ, Hewlett S, Bingham CO,
3rd, et al. Identifying core domains to assess flare in rheumatoid
arthritis: an OMERACT international patient and provider combined
Delphi consensus. Ann Rheum Dis. 2012;71(11):1855-1860.
- Sudore RL, Lum HD, You JJ, et al.
Defining Advance Care Planning for Adults: A Consensus Definition
From a Multidisciplinary Delphi Panel. J Pain Symptom Manage.
2017;53(5):821-832.e821.
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version on businesswire.com: https://www.businesswire.com/news/home/20190617005586/en/
Alex KepnesHumana Corporate Communications(502)
580-2990akepnes@humana.com
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